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Smoking related to mental illness reports new study

Robin Wulffson MD's picture
smoking, mental illness, education, poverty, young adults, Native Americans

Smoking is on the decline among many population groups in the United States. This trend is driven by factors such as increasing awareness of the health impact and the high cost of cigarettes. However, one population group is associated with a high level of smoking: those with mental illness. The findings were released on February 5 by the Centers for Disease Control and Prevention (CDC) and the Substance Abuse and Mental Health Services Administration (SAMHSA).

Tobacco use is the leading cause of preventable disease and death, according to the CDC. The study found that more than a third of adults with mental illness smoke, a rate that is approximately 70% higher than those with no mental illness. The investigators found that adults with mental illness are more likely to be heavy smokers and to have picked up the habit at an earlier age than smokers without mental illness. Furthermore, they are also less likely to succeed at quitting.

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The researchers accessed data from SAMHSA's national surveys from 2009 through 2011, which interviewed 138,000 adults in their homes from 2009 to 2011. The report analyzed a nationally representative sample of more than 67,000 Americans aged 12 or older. People were asked 14 questions to assess psychological distress and disability. Individuals with substance abuse or developmental disorders were not included in the study. In addition, the report did not include patients in psychiatric hospitals or individuals serving in the military. The investigators classified adults as having a mental illness according to their answers to questions based on two scientific measures of psychological distress and other social factors. The determination was not based on whether a person had been clinically diagnosed. The CDC noted that approximately 36% of adults with mental illness smoke, compared with 21% of adults with no mental illness. About 46 million American adults (nearly one in every five) have a mental illness or serious psychological distress, such as schizophrenia, phobias, or depression, according to the CDC.

The study revealed that a widening gulf in adult smoking rates between individuals with and without mental illness. The CDC notes that the study illustrates the need for broader adoption of smoking-cessation programs. The authors noted that contrary to perceptions, smokers with mental illness want to quit. The researchers found that smoking rates among those with mental illness were higher for young adults and Native Americans, as well as people with lower education levels and incomes below the poverty line.

The CDC notes that smoking rates for people with mental illness could improve with additional counseling, longer cessation programs, or increasing the number of tobacco-free campus policies at mental-health facilities. Another obstacle to smoking cessation programs found by the CDC was that mental health facilities have been reluctant to help patients quit smoking, over fears it would interfere with treatment. Some effects of nicotine can mask some of the negative effects of mental illness. In addition, smoking can make some medications less effective, which may then lead the individual with mental illness to smoke more to repress symptoms. Furthermore, individuals with mental illness, many of whom struggle to live a financially and socially stable life, may be less able to cope with withdrawal symptoms from quitting cigarettes.

Reference: CDC